| Blue Serenity Therapy Llc | |
|
15 Pamela Ln Sherwood AR 72120-2645 | |
| (501) 944-4660 | |
| Not Available |
| Full Name | Blue Serenity Therapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 15 Pamela Ln, Sherwood, Arkansas |
| Authorized Official Name and Position | Robin Michelle Jackson (OWNER) |
| Authorized Official Contact | 5019444660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Serenity Therapy Llc 15 Pamela Ln Sherwood AR 72120-2645 Ph: (501) 944-4660 | Blue Serenity Therapy Llc 15 Pamela Ln Sherwood AR 72120-2645 Ph: (501) 944-4660 |
| NPI Number | 1649081332 |
|---|---|
| Provider Enumeration Date | 01/14/2025 |
| Last Update Date | 02/03/2025 |
| Certification Date | 02/03/2025 |
| Medicare PECOS PAC ID | 4284154410 |
|---|---|
| Medicare Enrollment ID | O20250219000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649081332 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robin Michelle Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912212705 PECOS PAC ID: 3577862325 Enrollment ID: I20160428000951 |
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